Academic journal article Journal of Law and Health

Form & Reform: The Economic Realities of the United States Healthcare System

Academic journal article Journal of Law and Health

Form & Reform: The Economic Realities of the United States Healthcare System

Article excerpt

  I. GENERAL PROBLEMS WITH U.S. HEALTHCARE
 II. TWO PROPOSITIONS ABOUT THE PLAN
III. WHERE THE MAJOR DISAGREEMENT STARTS
 IV. PRE-EXISTING CONDITIONS
  V. CONCLUSION
     A. Areas for Possible Compromise
     B. Final Thoughts
     C. Questions From the Audience

MR. STEIGER:

Good afternoon, everybody. My name is Eric Steiger, I'm one of the editors-in-chief from the Journal of Law and Health. And I'm happy to welcome all of you to the second speaker event in the 2009/2010 Journal of Law and Health Speaker Series. Thank you all for coming.

Now, I know that the news last week was dominated by the story of Sandra Bullock's breakup; however, some of you might have noticed that a small piece of minor legislation also got passed through Congress last week And you also might have noticed that it wasn't quite as full of bipartisan support as it otherwise might have been. And so, the real question: Could it have been? What would such legislation have looked like? And what's the real difference between that and what we have now? And in order to help us answer that question, we have Professor Mark Votruba from Case Western Reserve's Weatherhead School of Management with us.

Professor Votruba has written on the allocation of medical resources, incentives for care, insurance markets, the effects of plant closings on communities, parental job loss and the link between divorced non-resident fathers' proximity and children's long-run outcomes. He has a Ph.D from Princeton University, and we're proud to have him here today. Everybody please give a warm welcome to Professor Mark Votruba.

PROFESSOR VOTRUBA:

I'll start by echoing Eric's sentiment that I was as surprised as anybody to see how quickly the healthcare reform debate came to a conclusion. Certainly, when Eric and I started exchanging e-mails about what I might talk about today, this wasn't the anticipated title for my talk. I originally thought the title of my talk was going to be "Is There a Bipartisan Solution for Healthcare Reform?" not "Was There a Bipartisan Solution for Healthcare Reform?" Given everything that happened in the weeks preceding the resolution--the Democrats losing their 60-seat super-majority in the Senate and the apparent lack of trust between House and Senate Democrats--the Democrats appeared unable to resolve the differences between the House and Senate versions of legislation. I assumed we would still be discussing the possibility of large-scale reform. Then, suddenly, the Democrats agreed to resolve their differences and found a legal means for passing the legislation without any Republican support. And here we are.

But I still think it is worth asking the question: was a bipartisan solution possible? I think the question is still relevant because understanding how a bipartisan solution might have been achieved might help us focus on issues that are going to get in the way of having productive public conversations in the future. And so, I hope that you will still find some value in this talk.

What I want to talk about is not necessarily the positives or the negatives of what happened, but instead I'd like to reflect on the way that it happened, and especially the fact that reform was passed without any support from Republicans. This was a major piece of legislation, where we normally would have expected the kind of bipartisan compromises represented in other landmark pieces of social legislation. In the last century of U.S. history, all major pieces of social legislation have been passed with broad bipartisan support, including Medicare and Medicaid, the Social Security Act, and the Civil Rights Act. Shouldn't this have been the case for healthcare reform? Shouldn't a bipartisan compromise of some sort been possible?

Certainly many people believe so. For instance, the following quote is from William Pewen, a former senior health policy advisor to Republican Olympia Snowe:

   Three in four Americans say the health care system needs to be
   overhauled, and many provisions in the pending legislation have
   strong support. … 
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